Trends in venous thromboembolism-related hospitalizations, 1994-2009
Boulet SL , Grosse SD , Thornburg CD , Yusuf H , Tsai J , Hooper WC . Pediatrics 2012 130 (4) e812-20 OBJECTIVE: Information on trends in venous thromboembolism (VTE) in US children is scant and inconsistent. We assessed national trends in VTE-associated pediatric hospitalizations. METHODS: All nonroutine newborn hospitalizations for children 0 to 17 years of age in the 1994-2009 Nationwide Inpatient Samples were included; routine newborn discharges were excluded. VTE diagnoses were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Variance weighted least square regression was used to assess trends in patient characteristics and rates of hospitalization per 100,000 population <18 years of age. Multivariable logistic regression models were used to estimate the probability of VTE diagnosis over the study period. RESULTS: The rate of VTE-associated hospitalization increased for all age subgroups (<1, 1-5, 6-11, and 12-17 years), with the largest increase noted among children <1 year of age (from 18.1 per 100,000 during 1994 to 49.6 per 100,000 during 2009). Compared with 1994-1997, the adjusted odds of hospitalization with a VTE diagnosis were 88% higher during 2006-2009 (adjusted odds ratio: 1.88 [95% confidence interval: 1.64-2.17]). Venous catheter use, mechanical ventilation, malignancy, hospitalization ≥5 days, and VTE-related medical conditions were associated with increased likelihood of VTE diagnosis. CONCLUSIONS: The rate of VTE-associated hospitalization among US children increased from 1994 through 2009. Increases in venous catheter procedures were associated with and may have contributed to the observed trends. The degree to which increased awareness of VTE influenced the temporal differences could not be determined. |
World Trade Center Health Program; addition of certain types of cancer to the list of WTC-related health conditions. Final rule
Centers for Disease Control and Prevention , Hearl FJ . Fed Regist 2012 77 (177) 56138-68 Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 amended the Public Health Service Act (PHS Act) to establish the World Trade Center (WTC) Health Program. The WTC Health Program, which is administered by the Director of the National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC), provides medical monitoring and treatment to eligible firefighters and related personnel, law enforcement officers, and rescue, recovery, and cleanup workers who responded to the September 11, 2001, terrorist attacks in New York City, at the Pentagon, and in Shanksville, Pennsylvania, and to eligible survivors of the New York City attacks. In accordance with WTC Health Program regulations, which establish procedures for adding a new condition to the list of covered health conditions, this final rule adds to the List of WTC-Related Health Conditions the types of cancer proposed for inclusion by the notice of proposed rulemaking. |
Magnetic resonance angiography-defined intracranial vasculopathy is associated with silent cerebral infarcts and glucose-6-phosphate dehydrogenase mutation in children with sickle cell anaemia
Thangarajh M , Yang G , Fuchs D , Ponisio MR , McKinstry RC , Jaju A , Noetzel MJ , Casella JF , Barron-Casella E , Hooper WC , Boulet SL , Bean CJ , Pyle ME , Payne AB , Driggers J , Trau HA , Vendt BA , Rodeghier M , Debaun MR . Br J Haematol 2012 159 (3) 352-9 Silent cerebral infarct (SCI) is the most commonly recognized cause of neurological injury in sickle cell anaemia (SCA). We tested the hypothesis that magnetic resonance angiography (MRA)-defined vasculopathy is associated with SCI. Furthermore, we examined genetic variations in glucose-6-phosphate dehydrogenase (G6PD) and HBA (alpha-globin) genes to determine their association with intracranial vasculopathy in children with SCA. Magnetic resonance imaging (MRI) of the brain and MRA of the cerebral vasculature were available in 516 paediatric patients with SCA, enrolled in the Silent Infarct Transfusion (SIT) Trial. All patients were screened for G6PD mutations and HBA deletions. SCI were present in 41.5% (214 of 516) of SIT Trial children. The frequency of intracranial vasculopathy with and without SCI was 15.9% and 6.3%, respectively (P < 0.001). Using a multivariable logistic regression model, only the presence of a SCI was associated with increased odds of vasculopathy (P = 0.0007, odds ratio (OR) 2.84; 95% Confidence Interval (CI) = 1.55-5.21). Among male children with SCA, G6PD status was associated with vasculopathy (P = 0.04, OR 2.78; 95% CI = 1.04-7.42), while no significant association was noted for HBA deletions. Intracranial vasculopathy was observed in a minority of children with SCA, and when present, was associated with G6PD status in males and SCI. |
Meta-analysis of 2040 sickle cell anemia patients: BCL11A and HBS1L-MYB are the major modifiers of HbF in African Americans
Bae HT , Baldwin CT , Sebastiani P , Telen MJ , Ashley-Koch A , Garrett M , Hooper WC , Bean CJ , Debaun MR , Arking DE , Bhatnagar P , Casella JF , Keefer JR , Barron-Casella E , Gordeuk V , Kato GJ , Minniti C , Taylor J , Campbell A , Luchtman-Jones L , Hoppe C , Gladwin MT , Zhang Y , Steinberg MH . Blood 2012 120 (9) 1961-2 Fetal hemoglobin (HbF) protects against many but not all of the hematologic and clinical complications of sickle cell anemia.1,2 This protection is dependent on the ability of HbF to hinder deoxyHbS polymerization. HbF level is variable and highly heritable. Previous genetic association studies found single nucleotide polymorphisms (SNPs) in regions of BCL11A (chromosome 2p), in the HBS1L-MYB intergenic polymorphism (HMIP; chromosome 6q), and linked to HBB (chromosome 11p) that were associated with HbF (reviewed in Akinsheye et al1). Our aim was to perform a meta-analysis of genome-wide association studies (GWAS) to find genetic loci with modest effect sizes that were associated with HbF when a larger sample size was examined. | Common SNPs (585, 563 total) from 7 cohorts totaling 2040 patients were meta-analyzed using the software Meta Analysis Helper (METAL)3 with inverse variance method, where effect estimates are weighted in proportion to their precisions.4 The 7 cohorts included in the meta-analysis are: Cooperative Study of Sickle Cell Disease (CSSCD: n = 841), Multicenter Study of Hydroxyurea (MSH: n = 178), Pulmonary Hypertension and the Hypoxic Response in Sickle Cell Disease (PUSH) study (n = 73), Comprehensive Sickle Cell Centers Collaborative Data (C-data) project (n = 127), Treatment of Pulmonary Hypertension and Sickle Cell Disease with Sildenafil Treatment (Walk-PHaSST) trial (n = 181), Duke University Outcome Modifying Genes study (n = 152), and Silent Infarct Transfusion (SIT) trial (n = 488). |
Eradication of factor VIII inhibitors in patients with mild and moderate hemophilia A
Kempton CL , Allen G , Hord J , Kruse-Jarres R , Pruthi RK , Walsh C , Young G , Soucie JM . Am J Hematol 2012 87 (9) 933-6 In hemophilia A, up to 25% of new antifactor VIII (FVIII) inhibitory antibodies (inhibitors) occur in patients with mild or moderate disease. Once the inhibitor develops, options for management include observation, immune modulation, and immune tolerance induction (ITI). Currently, there is little data to guide a clinician's management decisions. In a case series, eight of the 26 subjects with mild or moderate hemophilia complicated by an inhibitor underwent ITI; two were successful, two were unsuccessful, and four were partially successful. In a systematic review of the literature, 12 of the 16 patients with mild or moderate hemophilia responded to rituximab for treatment to eradicate the inhibitor. To increase our understanding of treatment options for inhibitor eradication in patients with mild or moderate hemophilia A complicated by an inhibitor, a secondary analysis of clinical and treatment characteristics in a cohort of 36 patients with mild or moderate hemophilia A and inhibitor was undertaken. In multivariate analyses, rituximab alone (n = 6) and other immune-modulating treatments alone (n = 2) were significantly associated with an increased likelihood of inhibitor clearance [hazard ratio (HR) = 4.4 (95% CI = 1.06-20.03) and 10.21 (95% CI = 1.17-78.28), respectively], whereas ITI alone (n = 9) was not [HR = 1.35 (95% CI = 0.44-4.07)]. |
EUROGIN 2011 roadmap on prevention and treatment of HPV-related disease
Arbyn M , de Sanjose S , Saraiya M , Sideri M , Palefsky J , Lacey C , Gillison M , Bruni L , Ronco G , Wentzensen N , Brotherton J , Qiao YL , Denny L , Bornstein J , Abramowitz L , Giuliano A , Tommasino M , Monsonego J . Int J Cancer 2012 131 (9) 1969-82 The EUROGIN 2011 roadmap reviews the current burden of human papillomavirus (HPV)-related morbidity, as well as the evidence and potential practice recommendations regarding primary and secondary prevention and treatment of cancers and other disease associated with HPV infection. HPV infection causes approximately 600,000 cases of cancer of the cervix, vulva, vagina, anus and oropharynx annually, as well as benign diseases such as genital warts and recurrent respiratory papillomatosis. Whereas the incidence of cervical cancer has been decreasing over recent decades, the incidence of anal and oropharyngeal carcinoma, for which there are no effective screening programs, has been rising over the last couple of decades. Randomized trials have demonstrated improved efficacy of HPV-based compared to cytology-based cervical cancer screening. Defining the best algorithms to triage HPV-positive women, age ranges and screening intervals are priorities for pooled analyses and further research, whereas feasibility questions can be addressed through screening programs. HPV vaccination will reduce the burden of cervical precancer and probably also of invasive cervical and other HPV-related disease in women. Recent trials demonstrated that prophylactic vaccination also protects against anogenital HPV infection, anogenital intraepithelial lesions and warts associated with vaccine types, in males; and anal HPV infection and anal intraepithelial neoplasia in MSM. HPV-related oropharyngeal cancer could be treated less aggressively because of better survival compared to cancers of the oropharynx unrelated to HPV. Key findings in the field of cervical cancer prevention should now be translated in cost-effective strategies, following an organized approach integrating primary and secondary prevention, according to scientific evidence but adapted to the local situation with particular attention to regions with the highest burden of disease. |
The implications of age and comorbidity on survival following epithelial ovarian cancer: summary and results from a Centers for Disease Control and Prevention study
O'Malley CD , Shema SJ , Cress RD , Bauer K , Kahn AR , Schymura MJ , Wike JM , Stewart SL . J Womens Health (Larchmt) 2012 21 (9) 887-94 BACKGROUND: Advances in treatment have improved ovarian cancer survival for most women, although less for the elderly. We report on this disparity and add further evidence about the relationship among age, comorbidity, and survival after ovarian cancer. METHODS: To examine age and comorbidity, Centers for Disease Control and Prevention (CDC)-funded cancer registries examined 2367 women residing in New York and Northern California diagnosed with epithelial ovarian cancer (1998-2000). Subjects were identified through tumor registries, treatment data were supplemented with physician survey, and comorbidity was identified through hospital discharge database linkages. Proportional hazards modeling was used to estimate the risk of death by age and comorbidity, adjusting for clinical and sociodemographic factors. RESULTS: Crude survival at 1 year and 3 years was 71.9% and 50.1%, respectively. Within stage, age-specific survival rates were lower in the oldest groups, particularly for those with advanced disease. For age 75+, 3-year survival was 13% vs. 50% in those <35 (stage IV). For all stages, women without comorbidity had higher survival rates than those with comorbidity. Older age and comorbidity were both associated with advanced stage and less aggressive treatment. The adjusted risk of death was 40%, and it was 80% higher for the 65-74 and 75+ groups, respectively, compared to women 35-64 (p<0.00). Comorbidity increased the risk of death by 40% (p<0.00). CONCLUSIONS: This study confirmed the independent adverse effects of age and comorbidity on survival following ovarian cancer. As the population ages, the co-occurrence of ovarian cancer and comorbidity will increase. Further work identifying critical conditions that impact survival could potentially inform complex treatment decisions. |
Modeling population immunity to support efforts to end the transmission of live polioviruses
Thompson KM , Pallansch MA , Tebbens RJ , Wassilak SG , Cochi SL . Risk Anal 2012 33 (4) 647-63 Eradication of wild poliovirus (WPV) types 1 and 3, prevention and cessation of circulating vaccine-derived polioviruses, and achievement and maintenance of a world free of paralytic polio cases requires active risk management by focusing on population immunity and coordinated cessation of oral poliovirus vaccine (OPV). We suggest the need for a complementary and different conceptual approach to achieve eradication compared to the current case-based approach using surveillance for acute flaccid paralysis (AFP) to identify symptomatic poliovirus infections. Specifically, we describe a modeling approach to characterize overall population immunity to poliovirus transmission. The approach deals with the realities that exposure to live polioviruses (e.g., WPV, OPV) and/or vaccination with inactivated poliovirus vaccine provides protection from paralytic polio (i.e., disease), but does not eliminate the potential for reinfection or asymptomatic participation in poliovirus transmission, which may increase with time because of waning immunity. The AFP surveillance system provides evidence of symptomatic poliovirus infections detected, which indicate immunity gaps after outbreaks occur, and this system represents an appropriate focus for controlling disease outbreaks. We describe a conceptual dynamic model to characterize population immunity to poliovirus transmission that helps identify risks created by immunity gaps before outbreaks occur, which provides an opportunity for national and global policymakers to manage the risk of poliovirus and prevent outbreaks before they occur. We suggest that dynamically modeling risk represents an essential tool as the number of cases approaches zero. |
Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients
Ahuja SD , Ashkin D , Avendano M , Banerjee R , Bauer M , Bayona JN , Becerra MC , Benedetti A , Burgos M , Centis R , Chan ED , Chiang CY , Cox H , D'Ambrosio L , Deriemer K , Dung NH , Enarson D , Falzon D , Flanagan K , Flood J , Garcia-Garcia ML , Gandhi N , Granich RM , Hollm-Delgado MG , Holtz TH , Iseman MD , Jarlsberg LG , Keshavjee S , Kim HR , Koh WJ , Lancaster J , Lange C , de Lange WC , Leimane V , Leung CC , Li J , Menzies D , Migliori GB , Mishustin SP , Mitnick CD , Narita M , O'Riordan P , Pai M , Palmero D , Park SK , Pasvol G , Pena J , Perez-Guzman C , Quelapio MI , Ponce-de-Leon A , Riekstina V , Robert J , Royce S , Schaaf HS , Seung KJ , Shah L , Shim TS , Shin SS , Shiraishi Y , Sifuentes-Osornio J , Sotgiu G , Strand MJ , Tabarsi P , Tupasi TE , van Altena R , Van der Walt M , Van der Werf TS , Vargas MH , Viiklepp P , Westenhouse J , Yew WW , Yim JJ . PLoS Med 2012 9 (8) e1001300 BACKGROUND: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. METHODS AND FINDINGS: Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]). CONCLUSIONS: In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. (Please see later in the article for the Editors' Summary.) |
Fatal wild-type varicella-zoster virus encephalitis without a rash in a vaccinated child
Ibraheem M , Marin M , Leung J , Bryce CH , Schmid DS , Zaki SR , Drew C , Liu L , Smelser C . Pediatr Infect Dis J 2012 32 (2) 183-5 Encephalitis associated with varicella-zoster virus (VZV), rare among children in the varicella vaccine era, has generally been associated with a rash. We report fatal wild-type VZV encephalitis without a rash in a child who had received 1 dose of varicella vaccine. VZV encephalitis should be considered in the differential diagnosis for children presenting with acute neurologic symptoms, even vaccine recipients. |
HIV testing among patients infected with Neisseria gonorrhoeae: STD Surveillance Network, United States, 2009-2010
Bradley H , Asbel L , Bernstein K , Mattson M , Pathela P , Mohamed M , Samuel MC , Schwebke J , Stenger M , Tabidze I , Zenilman J , Dowell D , Weinstock H . AIDS Behav 2012 17 (3) 1205-10 We used data from the STD Surveillance Network to estimate HIV testing among patients being tested or treated for gonorrhea. Of 1,845 gonorrhea-infected patients identified through nationally notifiable disease data, only 51% were tested for HIV when they were tested or treated for gonorrhea. Among the 10 geographic sites in this analysis, the percentage of patients tested for HIV ranged from 22-63% for men and 20-79% for women. Nearly 33% of the un-tested patients had never been previously HIV-tested. STD clinic patients were more likely to be HIV-tested than those in other practice settings. |
Baseline characteristics and mortality among people in care for chronic viral hepatitis: the Chronic Hepatitis Cohort Study (CHeCS)
Moorman AC , Gordon SC , Rupp LB , Spradling PR , Teshale EH , Lu M , Nerenz DR , Nakasato CC , Boscarino JA , Henkle EM , Oja-Tebbe NJ , Xing J , Ward JW , Holmberg SD . Clin Infect Dis 2012 56 (1) 40-50 BACKGROUND: The Chronic Hepatitis Cohort Study (CHeCS), a dynamic prospective, longitudinal, observational cohort study, was created to assess the clinical impact of chronic viral hepatitis in the United States. This report describes the cohort selection process and baseline demographics, insurance, biopsy, hospitalization and mortality rates. METHODS: Electronic health records (EHR) of over 1.6 million adult patients seen January 2006 - December 2010 at four integrated health care systems in Detroit, MI, Danville, PA, Portland, OR, and Honolulu, HI were collected and analyzed. RESULTS: Of 2202 patients with chronic hepatitis B virus (HBV) infection: 50% were aged 44-63; 57% male; 58% Asian/Pacific Islanders (API), and 13% Black; and 5.1% were on Medicaid, 16.5% had Medicare, and 76.3% private insurance. During 2001-2010, 22.3% had a liver biopsy and 37.9% were hospitalized. For the 8810 patients with chronic hepatitis C virus (HCV) infection: 75% were aged 44-63 years; 60% male; 23% Black; and 12% were on Medicaid, 23% Medicare, and 62% had private insurance. During 2001-2010, 38.4% had a liver biopsy and 44.3% were hospitalized. Among persons in care, 9.0% of persons with HBV and 14.0% of persons with HCV infection, mainly those born 1945-1964, died during the 2006-10 five-year period. CONCLUSIONS: Baseline demographic, hospitalization, and mortality data from CHeCS highlight the substantial US health burden from chronic viral hepatitis, particularly among persons born 1945-1964. |
Controlling HIV epidemics among injection drug users: eight years of cross-border HIV prevention interventions in Vietnam and China
Hammett TM , Des Jarlais DC , Kling R , Kieu BT , McNicholl JM , Wasinrapee P , McDougal JS , Liu W , Chen Y , Meng D , Doan N , Huu Nguyen T , Ngoc Hoang Q , Van Hoang T . PLoS One 2012 7 (8) e43141 INTRODUCTION: HIV in Vietnam and Southern China is driven by injection drug use. We have implemented HIV prevention interventions for IDUs since 2002-2003 in Lang Son and Ha Giang Provinces, Vietnam and Ning Ming County (Guangxi), China. METHODS: Interventions provide peer education and needle/syringe distribution. Evaluation employed serial cross-sectional surveys of IDUs 26 waves from 2002 to 2011, including interviews and HIV testing. Outcomes were HIV risk behaviors, HIV prevalence and incidence. HIV incidence estimation used two methods: 1) among new injectors from prevalence data; and 2) a capture enzyme immunoassay (BED testing) on all HIV+ samples. RESULTS: We found significant declines in drug-related risk behaviors and sharp reductions in HIV prevalence among IDUs (Lang Son from 46% to 23% [p<0.001], Ning Ming: from 17% to 11% [p = 0.003], and Ha Giang: from 51% to 18% [p<0.001]), reductions not experienced in other provinces without such interventions. There were significant declines in HIV incidence to low levels among new injectors through 36-48 months, then some rebound, particularly in Ning Ming, but BED-based estimates revealed significant reductions in incidence through 96 months. DISCUSSION: This is one of the longest studies of HIV prevention among IDUs in Asia. The rebound in incidence among new injectors may reflect sexual transmission. BED-based estimates may overstate incidence (because of false-recent results in patients with long-term infection or on ARV treatment) but adjustment for false-recent results and survey responses on duration of infection generally confirm BED-based incidence trends. Combined trends from the two estimation methods show sharp declines in incidence to low levels. The significant downward trends in all primary outcome measures indicate that the Cross-Border interventions played an important role in bringing HIV epidemics among IDUs under control. The Cross-Border project offers a model of HIV prevention for IDUs that should be considered for large-scale replication. |
The dengue virus mosquito vector Aedes aegypti at high elevation in Mexico
Lozano-Fuentes S , Hayden MH , Welsh-Rodriguez C , Ochoa-Martinez C , Tapia-Santos B , Kobylinski KC , Uejio CK , Zielinski-Gutierrez E , Monache LD , Monaghan AJ , Steinhoff DF , Eisen L . Am J Trop Med Hyg 2012 87 (5) 902-9 Mexico has cities (e.g., Mexico City and Puebla City) located at elevations > 2,000 m and above the elevation ceiling, below which local climates allow the dengue virus mosquito vector Aedes aegypti to proliferate. Climate warming could raise this ceiling and place high-elevation cities at risk for dengue virus transmission. To assess the elevation ceiling for Ae. aegypti and determine the potential for using weather/climate parameters to predict mosquito abundance, we surveyed 12 communities along an elevation/climate gradient from Veracruz City (sea level) to Puebla City (?2,100 m). Ae. aegypti was commonly encountered up to 1,700 m and present but rare from 1,700 to 2,130 m. This finding extends the known elevation range in Mexico by > 300 m. Mosquito abundance was correlated with weather parameters, including temperature indices. Potential larval development sites were abundant in Puebla City and other high-elevation communities, suggesting that Ae. aegypti could proliferate should the climate become warmer. |
Plain language summaries: a new EHS-net tool to share our published findings
Brown LG , Wigington PS . J Environ Health 2012 75 (2) 30-1 The Centers for Disease Control and Prevention’s (CDC’s) Environmental Health | Specialists Network (EHS-Net) is a collaborative network focused on understanding | contributing factors to foodborne illness and | improving environmental public health practice | (www.cdc.gov/nceh/ehs/EHSNet/index.htm). | EHS-Net includes environmental public health | and food safety professionals from CDC, Food | and Drug Administration, U.S. Department of | Agriculture, and six state and local health departments (California, Minnesota, New York, | New York City, Rhode Island, and Tennessee). | EHS-Net’s composition means it is uniquely | positioned to conduct high-quality research on | food safety, particularly restaurant food safety |
Comparison of polyfluoroalkyl compound concentrations in maternal serum and amniotic fluid: a pilot study
Stein CR , Wolff MS , Calafat AM , Kato K , Engel SM . Reprod Toxicol 2012 34 (3) 312-6 The extent to which polyfluoroalkyl compounds (PFCs) are detectable in amniotic fluid is unknown. Using paired samples from 28 women, we compared the concentration of 8 PFCs measured in serum, the standard matrix for assessing human exposure, amniotic fluid from routine amniocentesis, and urine. Perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorooctane sulfonate (PFOS), and perfluorohexane sulfonate (PFHxS) were detected in all maternal serum samples. The number of amniotic fluid samples with detectable concentrations differed by PFC (PFOA n=24; PFNA n=10; PFOS n=9; PFHxS n=4). The correlation coefficient between maternal serum and amniotic PFC levels varied considerably by PFC (PFOA rho=0.64, p<0.001; PFNA rho=0.05, p=0.9; PFOS rho=0.76, p=0.01; PFHxS rho=0.80, p=0.2). Using linear regression, PFOA appeared to be commonly detected in amniotic fluid if the serum concentration exceeded approximately 1.5ng/mL whereas PFOS was rarely detected in amniotic fluid until the serum concentration was about 5.5ng/mL. No PFCs were detected in urine. |
Short report: improving record-review surveillance of young children with an autism spectrum disorder
Wiggins LD , Robins DL , Yeargin-Allsopp M . Autism 2012 17 (5) 623-9 INTRODUCTION: Records-based autism spectrum disorder surveillance developed at the Centers for Disease Control and Prevention has been extended to younger cohorts, although the utility of additional record sources has not been examined. We therefore conducted a pilot project to describe whether Centers for Disease Control and Prevention surveillance could identify younger children with an autism spectrum disorder evaluated as part of an ongoing screening study at Georgia State University. METHODS: In all, 31 families of children who screened positive for autism spectrum disorder and received a clinical evaluation at Georgia State University agreed to participate in the project. Of these, 10 children lived inside the surveillance area and had records abstracted and reviewed for this project. Centers for Disease Control and Prevention surveillance results (i.e. autism spectrum disorder or non-autism spectrum disorder) were compared with Georgia State University evaluation results (i.e. autism spectrum disorder or non-autism spectrum disorder). RESULTS: In all, 4 of the 10 children were diagnosed with an autism spectrum disorder after the Georgia State University evaluation. None of the 4 children with an autism spectrum disorder were identified by current Centers for Disease Control and Prevention surveillance methods but all 4 children were identified by Centers for Disease Control and Prevention surveillance methods when additional record sources were included (i.e. records from the statewide early intervention program and Georgia State University evaluation). CONCLUSION: These findings suggest that partnering with early intervention programs and encouraging early autism spectrum disorder screening might improve autism spectrum disorder surveillance among young children. |
Objective surveillance definitions for ventilator-associated pneumonia
Klompas M , Magill S , Robicsek A , Strymish JM , Kleinman K , Evans RS , Lloyd JF , Khan Y , Yokoe DS , Stevenson K , Samore M , Platt R . Crit Care Med 2012 40 (12) 3154-61 OBJECTIVES: The subjectivity and complexity of surveillance definitions for ventilator-associated pneumonia preclude meaningful internal or external benchmarking and therefore hamper quality improvement initiatives for ventilated patients. We explored the feasibility of creating objective surveillance definitions for ventilator-associated pneumonia. DESIGN: We identified clinical signs suitable for inclusion in objective definitions, proposed candidate definitions incorporating these objective signs, and then applied these definitions to retrospective clinical data to measure their frequencies and associations with adverse outcomes using multivariate regression models for cases and matched controls. SETTING: Medical and surgical intensive care units in eight U.S. hospitals (four tertiary centers, three community hospitals, and one Veterans Affairs institution). PATIENTS: Eight thousand seven hundred thirty-five consecutive episodes of mechanical ventilation for adult patients. INTERVENTIONS: We evaluated 32 different candidate definitions composed of different combinations of the following signs: three thresholds for respiratory deterioration defined by sustained increases in daily minimum positive end-expiratory pressure or FIO2 after either 2 or 3 days of stable or decreasing ventilator settings, abnormal temperature, abnormal white blood cell count, purulent pulmonary secretions defined by neutrophils on Gram stain, and positive cultures for pathogenic organisms. MEASUREMENTS AND MAIN RESULTS: Ventilator-associated pneumonia incidence, attributable ventilator days, hospital days, and hospital mortality. All candidate definitions were significantly associated with increased ventilator days and hospital days, but only definitions requiring objective evidence of respiratory deterioration were significantly associated with increased hospital mortality. Significant odds ratios for hospital mortality ranged from 1.9 (95% confidence interval 1.2-2.9) to 6.1 (95% confidence interval 2.2-17). Requiring additional clinical signs beyond respiratory deterioration alone decreased event rates, had little impact on attributable lengths of stay, and diminished sensitivity and positive predictive values for hospital mortality. CONCLUSIONS: Objective surveillance definitions that include quantitative evidence of respiratory deterioration after a period of stability strongly predict increased length of stay and hospital mortality. These definitions merit further evaluation of their utility for hospital quality and safety improvement programs. |
Estimating influenza incidence and rates of influenza-like illness in the outpatient setting
Fowlkes A , Dasgupta S , Chao E , Lemmings J , Goodin K , Harris M , Martin K , Feist M , Wu W , Boulton R , Temte J , Brammer L , Finelli L . Influenza Other Respir Viruses 2012 7 (5) 694-700 BACKGROUND: Estimating influenza incidence in outpatient settings is challenging. We used outpatient healthcare practice populations as a proxy to estimate community incidence of influenza-like illness (ILI) and laboratory-confirmed influenza-associated ILI. METHODS: From October 2009 to July 2010, 38 outpatient practices in seven jurisdictions conducted surveillance for ILI (fever with cough or sore throat for patients ≥2 years; fever with ≥1 respiratory symptom for patients <2 years). From a sample of patients with ILI, respiratory specimens were tested for influenza. RESULTS: During the week of peak influenza activity (October 24, 2009), 13% of outpatient visits were for ILI and influenza was detected in 72% of specimens. For the 10-month surveillance period, ILI and influenza-associated ILI incidence were 20.0 (95% CI: 19.7, 20.4) and 8.7/1000 (95% CI: 8.2, 9.2) persons, respectively. Influenza-associated ILI incidence was highest among children aged 2-17 years. Observed trends were highly correlated with national ILI and virologic surveillance. CONCLUSIONS: This is the first multistate surveillance system demonstrating the feasibility of using outpatient practices to estimate the incidence of medically attended influenza at the community level. Surveillance demonstrated the substantial burden of pandemic influenza in outpatient settings and especially in children aged 2-17 years. Observed trends were consistent with established syndromic and virologic systems. |
Epidemiology of foodborne norovirus outbreaks, United States, 2001-2008
Hall AJ , Eisenbart VG , Etingue AL , Gould LH , Lopman BA , Parashar UD . Emerg Infect Dis 2012 18 (10) 1566-73 Noroviruses are the leading cause of foodborne illness in the United States. To better guide interventions, we analyzed 2,922 foodborne disease outbreaks for which norovirus was the suspected or confirmed cause, which had been reported to the Foodborne Disease Outbreak | Surveillance System of the Centers for Disease Control and Prevention during 2001-2008. On average, 365 foodborne norovirus outbreaks were reported annually, resulting in an estimated 10,324 illnesses, 1,247 health care provider visits, 156 hospitalizations, and 1 death. In 364 outbreaks attributed to a single commodity, leafy vegetables (33%), fruits/nuts (16%), and mollusks (13%) were implicated most commonly. Infected food handlers were the source of 53% of outbreaks and may have contributed to 82% of outbreaks. Most foods were likely contaminated during preparation and service, except for mollusks, and occasionally, produce was contaminated during production and processing. Interventions to reduce the frequency of foodborne norovirus outbreaks should focus on food workers and production of produce and shellfish. |
Development of a consensus method for culture of Clostridium difficile from meat and its use in a survey of U.S. retail meats
Limbago B , Thompson AD , Greene SA , MacCannell D , Macgowan CE , Jolbitado B , Hardin HD , Estes SR , Weese JS , Songer JG , Gould LH . Food Microbiol 2012 32 (2) 448-51 Three previously described methods for culture of Clostridium difficile from meats were evaluated by microbiologists with experience in C. difficile culture and identification. A consensus protocol using BHI broth enrichment followed by ethanol shock and plating to selective and non-selective media was selected for use, and all participating laboratories received hands-on training in the use of this method prior to study initiation. Retail meat products (N = 1755) were cultured for C. difficile over 12 months during 2010-2011 at 9 U.S. FoodNet sites. No C. difficile was recovered, although other clostridia were isolated. |
Tumor necrosis factor -308 polymorphism (rs1800629) is associated with mortality and ventilator duration in 1057 Caucasian patients.
Watanabe E , Zehnbauer BA , Oda S , Sato Y , Hirasawa H , Buchman TG . Cytokine 2012 60 (1) 249-56 PURPOSE: Management of sepsis in critically ill patients remains difficult and requires prolonged intensive care. Genetic testing has been proposed as a strategy to identify patients at risk for adverse outcome of critical illnesses. Therefore, we wished to determine the influence of heredity on predisposition to poor outcome and on duration of ventilator support of intensive care unit (ICU) patients. METHODS: A study was conducted from July 2001 to December 2005 in heterogeneous population of patients from 12 US ICUs represented by the Genetic Predisposition to Severe Sepsis (GenPSS) archive. In 1057 Caucasian critically ill patients with SAPS II probability of survival of >0.2 in the US, six functional single nucleotide polymorphisms in relation to inflammatory cytokines and innate immunity (rs1800629, rs16944, rs1800795, rs1800871, rs2569190, and rs909253) were evaluated in terms of mortality and ventilator free days. RESULTS: The AA homozygote of TNF(-308) (rs1800629) was most over-represented in the deceased patient group (P=0.015 with recessive model). The carriage of the TNF(-308)*AA genotype showed significantly higher odds ratio of 2.67(1.29-5.55) (P=0.008) after adjustment with the covariates. However, the presence of 1, 2, or 3 acute organ dysfunctions was larger prognostic factors for the adverse outcome (OR(95%CI)=2.98(2.00-4.45), 4.01(2.07-7.77), or 19.95(4.99-79.72), P<0.001 for all). Kaplan-Mayer plot on ventilator duration of TNF(-308)*AA patient significantly diverged from that of TNF(-308)*(GG+GA) ((AA v GG+GA), Adjusted HR(95%CI)=2.53(1.11-5.79) with Cox regression, P=0.028). CONCLUSIONS: TNF(-308)*AA is significantly associated with susceptibility to adverse outcome and to longer ventilator duration. Therefore, heredity likely affects both predisposition to ICU prognosis as well as the resource utilization. |
Genetic variants in antioxidant genes are associated with diisocyanate-induced asthma.
Yucesoy B , Johnson VJ , Lummus ZL , Kissling GE , Fluharty K , Gautrin D , Malo JL , Cartier A , Boulet LP , Sastre J , Quirce S , Germolec DR , Tarlo SM , Cruz MJ , Munoz X , Luster MI , Bernstein DI . Toxicol Sci 2012 129 (1) 166-73 Diisocyanates are a common cause of occupational asthma, but risk factors are not well defined. A case-control study was conducted to investigate whether genetic variants of antioxidant defense genes, glutathione S-transferases (GSTM1, GSTT1, GSTM3, GSTP1), manganese superoxide dismutase (SOD2), and microsomal epoxide hydrolase (EPHX1) are associated with increased susceptibility to diisocyanate-induced asthma (DA). The main study population consisted of 353 Caucasian French-Canadians from among a larger sample of 410 diisocyanate-exposed workers in three groups: workers with specific inhalation challenge (SIC) confirmed DA (DA(+), n = 95); symptomatic diisocyanate workers with a negative SIC (DA(-), n = 116); and asymptomatic exposed workers (AW, n = 142). Genotyping was performed on genomic DNA, using a 5'-nuclease PCR assay. The SOD2 rs4880, GSTP1 rs1695, and EPHX1 rs2740171 variants were significantly associated with DA in both univariate and multivariate analyses. In the first logistic regression model comparing DA(+) and DA(-) groups, SOD2 rs4880, GSTM1 (null), GSTP1 rs762803, and EPHX1 rs2854450 variants were associated with DA (p = 0.004, p = 0.047, p = 0.021, p <0.001, respectively). Genotype combinations GSTT1*GSTP1 rs762803, GSTM1*EPHX1 rs2854450, EPHX1 rs2740168*EPHX1 rs1051741, and GSTP1 rs762803*EPHX1 rs2740168 were also associated with DA in this model (p = 0.027, p = 0.002, p = 0.045, p = 0.044, respectively). The GSTP1 rs1695 and EPHX1 rs1051741 and rs2740171 variants showed an association with DA in the second model comparing DA(+) and AW groups (p = 0.040, p = 0.019, p = 0.002, respectively). The GSTM3 rs110913*EPHX1 rs1051741 genotype combination was also associated with DA under this model (p = 0.042). The results suggest that variations in SOD2, GST, and EPHX1 genes and their interactions contribute to DA susceptibility. |
Public health action in genomics is now needed beyond newborn screening.
Bowen MS , Kolor K , Dotson WD , Ned RM , Khoury MJ . Public Health Genomics 2012 15 (6) 327-34 For decades, newborn screening was the only public health program in the US focused on reducing morbidity, mortality and disability in people affected by genetic conditions. The landscape has changed, however, as evidence-based recommendations are now available for several other genomic applications that can save lives now in the US. Many more such applications are expected to emerge in the next decade. An action plan, based on evidence, provides the impetus for a new paradigm for public health practice in genomics across the lifespan using established multilevel processes as a guide. These include policy interventions, education, clinical interventions, and surveillance. Applying what we know today in hereditary breast/ovarian cancer, Lynch syndrome and familial hypercholesterolemia has the potential to affect thousands of people in the US population every year. Enhanced partnerships between genetic and nongenetic providers of clinical medicine and public health are needed to overcome the challenges for implementing genomic medicine applications both now and in the future. |
Associations between partner-venue specific personal responsibility beliefs and transmission risk behavior by HIV-positive men who have sex with men (MSM)
O'Leary A , Horvath KJ , Simon Rosser BR . AIDS Behav 2012 17 (5) 1855-61 Personal responsibility beliefs of HIV-positive individuals to protect sex partners are an important determinant of engagement in transmission risk behavior. However, the degree to which such beliefs vary across different partners is unknown. HIV-positive men who have sex with men (n = 248) completing an online survey rated their personal responsibility beliefs for partners met in up to four different ways: (a) in a bar; (b) through the internet; (c) in a public sex environment (PSE); or (d) through friends or family. For those reporting two or more partner-meeting venues in the prior 3 months (n = 98), about a third reported variation in responsibility ratings. Means among the venues were compared in pairwise fashion, with the strongest beliefs accruing to partners met through friends or family and the least with partners met in PSEs. These results provide further evidence that identifying ways to increase personal responsibility beliefs is an important goal, as well as is the application of Bandura's theory of moral agency to HIV transmission risk behavior. |
The safety of adjuvants in influenza vaccines during pregnancy: what do we know and why do we need them?
Jamieson DJ , Rasmussen SA . Am J Obstet Gynecol 2012 207 (3) 145-6 The high mortality rates observed among pregnant women during the 1957 through 1958 influenza pandemic prompted the US Surgeon General to issue a report in 1960 that recommended routine seasonal influenza vaccination for pregnant women.1 During the past half century, recommendations in the United States have evolved, with influenza vaccination recommended for all pregnant women regardless of trimester beginning in 2004. Despite these recommendations, influenza vaccination rates among pregnant women were generally low (<15%) until the 2009 H1N1 influenza A pandemic when vaccination rates increased to about 50%.2 Although these higher vaccination rates have been sustained,2 we are still a long way from the goal of ensuring that all pregnant women are vaccinated against influenza. Part of the challenge with achieving this goal has been lingering concerns about safety of vaccination during pregnancy.2 |
Smoke alarm giveaway and installation programs: an economic evaluation
Liu Y , Mack KA , Diekman ST . Am J Prev Med 2012 43 (4) 385-91 BACKGROUND: The burden of residential fire injury and death is substantial. Targeted smoke alarm giveaway and installation programs are popular interventions used to reduce residential fire mortality and morbidity. PURPOSE: To evaluate the cost effectiveness and cost benefit of implementing a giveaway or installation program in a small hypothetic community with a high risk of fire death and injury through a decision-analysis model. METHODS: Model inputs included program costs; program effectiveness (life-years and quality-adjusted life-years saved); and monetized program benefits (medical cost, productivity, property loss and quality-of-life losses averted) and were identified through structured reviews of existing literature (done in 2011) and supplemented by expert opinion. Future costs and effectiveness were discounted at a rate of 3% per year. All costs were expressed in 2011 U.S. dollars. RESULTS: Cost-effectiveness analysis (CEA) resulted in an average cost-effectiveness ratio (ACER) of $51,404 per quality-adjusted life-years (QALYs) saved and $45,630 per QALY for the giveaway and installation programs, respectively. Cost-benefit analysis (CBA) showed that both programs were associated with a positive net benefit with a benefit-cost ratio of 2.1 and 2.3, respectively. Smoke alarm functional rate, baseline prevalence of functional alarms, and baseline home fire death rate were among the most influential factors for the CEA and CBA results. CONCLUSIONS: Both giveaway and installation programs have an average cost-effectiveness ratio similar to or lower than the median cost-effectiveness ratio reported for other interventions to reduce fatal injuries in homes. Although more effort is required, installation programs result in lower cost per outcome achieved compared with giveaways. |
Metabolomic profiling of amino acids and beta-cell function relative to insulin sensitivity in youth
Michaliszyn SF , Sjaarda LA , Mihalik SJ , Lee S , Bacha F , Chace DH , De Jesus VR , Vockley J , Arslanian SA . J Clin Endocrinol Metab 2012 97 (11) E2119-24 CONTEXT: In longitudinal studies of adults, elevated amino acid (AA) concentrations predicted future type 2 diabetes mellitus (T2DM). OBJECTIVE: The aim of the present investigation was to examine whether increased plasma AA concentrations are associated with impaired beta-cell function relative to insulin sensitivity [i.e. disposition index (DI)], a predictor of T2DM development. DESIGN, SETTING, AND PARTICIPANTS: Metabolomic analysis for fasting plasma AAs was performed by tandem mass spectrometry in 139 normal-weight and obese adolescents with and without dysglycemia. First-phase insulin secretion was evaluated by a hyperglycemic ( approximately 225 mg/dl) clamp and insulin sensitivity by a hyperinsulinemic-euglycemic clamp. DI was calculated as the product of first-phase insulin and insulin sensitivity. RESULTS: DI was positively associated with branched-chain AAs (leucine/isoleucine and valine; r = 0.27 and 0.29, P = 0.001), neutrally transported AAs (phenylalanine and methionine; r = 0.30 and 0.35, P < 0.001), basic AAs (histidine and arginine; r = 0.28 and 0.23, P ≤ 0.007), serine (r = 0.35, P < 0.001), glycine (r = 0.26, P = 0.002), and branched-chain AAs-derived intermediates C3, C4, and C5 acylcarnitine (range r = 0.18-0.19, P ≤ 0.04). CONCLUSION: In youth, increased plasma AA concentrations are not associated with a heightened metabolic risk profile for T2DM; rather, they are positively associated with beta-cell function relative to insulin sensitivity. These contrasting observations between adults and youth may be a reflection of developmental differences along the lifespan dependent on the combined impact of the aging process together with the impact of progressive obesity. |
Evaluation of physical sampling efficiency for cyclone-based personal bioaerosol samplers in moving air environments
Su WC , Tolchinsky AD , Chen BT , Sigaev VI , Cheng YS . J Environ Monit 2012 14 (9) 2430-7 The need to determine occupational exposure to bioaerosols has notably increased in the past decade, especially for microbiology-related workplaces and laboratories. Recently, two new cyclone-based personal bioaerosol samplers were developed by the National Institute for Occupational Safety and Health (NIOSH) in the USA and the Research Center for Toxicology and Hygienic Regulation of Biopreparations (RCT & HRB) in Russia to monitor bioaerosol exposure in the workplace. Here, a series of wind tunnel experiments were carried out to evaluate the physical sampling performance of these two samplers in moving air conditions, which could provide information for personal biological monitoring in a moving air environment. The experiments were conducted in a small wind tunnel facility using three wind speeds (0.5, 1.0 and 2.0 m s(-1)) and three sampling orientations (0 degrees , 90 degrees , and 180 degrees ) with respect to the wind direction. Monodispersed particles ranging from 0.5 to 10 mcm were employed as the test aerosols. The evaluation of the physical sampling performance was focused on the aspiration efficiency and capture efficiency of the two samplers. The test results showed that the orientation-averaged aspiration efficiencies of the two samplers closely agreed with the American Conference of Governmental Industrial Hygienists (ACGIH) inhalable convention within the particle sizes used in the evaluation tests, and the effect of the wind speed on the aspiration efficiency was found negligible. The capture efficiencies of these two samplers ranged from 70% to 80%. These data offer important information on the insight into the physical sampling characteristics of the two test samplers. |
Evaluation of the Tetracore Orthopox BioThreat(R) antigen detection assay using laboratory grown orthopoxviruses and rash illness clinical specimens
Townsend MB , Macneil A , Reynolds MG , Hughes CM , Olson VA , Damon IK , Karem KL . J Virol Methods 2012 187 (1) 37-42 The commercially available Orthopox BioThreat((R)) Alert assay for orthopoxvirus (OPV) detection is piloted. This antibody-based lateral-flow assay labels and captures OPV viral agents to detect their presence. Serial dilutions of cultured Vaccinia virus (VACV) and Monkeypox virus (MPXV) were used to evaluate the sensitivity of the Tetracore assay by visual and quantitative determinations; specificity was assessed using a small but diverse set of diagnostically relevant blinded samples from viral lesions submitted for routine OPV diagnostic testing. The BioThreat((R)) Alert assay reproducibly detected samples at concentrations of 10(7)pfu/ml for VACV and MPXV and positively identified samples containing 10(6)pfu/ml in 4 of 7 independent experiments. The assay correctly identified 9 of 11 OPV clinical samples and had only one false positive when testing 11 non-OPV samples. Results suggest applicability for use of the BioThreat((R)) Alert assay as a rapid screening assay and point of care diagnosis for suspect human monkeypox cases. |
Aspergillus bertholletius sp. nov. from brazil nuts
Taniwaki MH , Pitt JI , Iamanaka BT , Sartori D , Copetti MV , Balajee A , Fungaro MH , Frisvad JC . PLoS One 2012 7 (8) e42480 During a study on the mycobiota of brazil nuts (Bertholletia excelsa) in Brazil, a new Aspergillus species, A. bertholletius, was found, and is described here. A polyphasic approach was applied using morphological characters, extrolite data as well as partial beta-tubulin, calmodulin and ITS sequences to characterize this taxon. A. bertholletius is represented by nineteen isolates from samples of brazil nuts at various stages of production and soil close to Bertholletia excelsa trees. The following extrolites were produced by this species: aflavinin, cyclopiazonic acid, kojic acid, tenuazonic acid and ustilaginoidin C. Phylogenetic analysis using partial beta-tubulin and camodulin gene sequences showed that A. bertholletius represents a new phylogenetic clade in Aspergillus section Flavi. The type strain of A. bertholletius is CCT 7615 ( = ITAL 270/06 = IBT 29228). |
The burden and consequences of inherited blood disorders among young children in western Kenya.
Suchdev PS , Ruth LJ , Earley M , Macharia A , Williams TN . Matern Child Nutr 2012 10 (1) 135-44 Although inherited blood disorders are common among children in many parts of Africa, limited data are available about their prevalence or contribution to childhood anaemia. We conducted a cross-sectional survey of 858 children aged 6-35 months who were randomly selected from 60 villages in western Kenya. Haemoglobin (Hb), ferritin, malaria, C-reactive protein (CRP) and retinol binding protein (RBP) were measured from capillary blood. Using polymerase chain reaction (PCR), Hb type, -3.7 kb alpha-globin chain deletion, glucose-6-phosphate dehydrogenase (G6PD) genotype and haptoglobin (Hp) genotype were determined. More than 2 out of 3 children had at least one measured blood disorder. Sickle cell trait (HbAS) and disease (HbSS) were found in 17.1% and 1.6% of children, respectively; 38.5% were heterozygotes and 9.6% were homozygotes for alpha(+) -thalassaemia. The Hp 2-2 genotype was found in 20.4% of children, whereas 8.2% of males and 6.8% of children overall had G6PD deficiency. There were no significant differences in the distribution of malaria by the measured blood disorders, except among males with G6PD deficiency who had a lower prevalence of clinical malaria than males of normal G6PD genotype (P = 0.005). After excluding children with malaria parasitaemia, inflammation (CRP > 5 mg L(-1) ), iron deficiency (ferritin < 12 mcg L(-1) ) or vitamin A deficiency (RBP < 0.7 mcg L(-1) ), the prevalence of anaemia among those without alpha(+) -thalassaemia (43.0%) remained significantly lower than that among children who were either heterozygotes (53.5%) or homozygotes (67.7%, P = 0.03). Inherited blood disorders are common among pre-school children in western Kenya and are important contributors to anaemia. |
Rates and success rates of trial of labor after Cesarean delivery in the United States, 1990-2009
Uddin SF , Simon AE . Matern Child Health J 2012 17 (7) 1309-14 This study compares rates of trial of labor after Cesarean delivery (TOLAC) and rates of successful TOLAC between 1990 and 2009. Serial cross-sectional analyses were performed using the National Hospital Discharge Survey data to compare rates of TOLAC and TOLAC success between 1990 and 2009. Joinpoint regression was used to assess trends over time, and logistic regression with marginal effects was used to examine the unadjusted and adjusted significance and magnitude of trends. The rate of TOLAC reached a high of 51.8 % (95 % CI 47.8-55.8 %) in 1995 and a low of 15.9 % (95 % CI 13.8-18.0 %) in 2006, declined, on average, 4.2 (95 % CI -4.8 to -3.9) percentage points per year between 1996 and 2005. Rates increased significantly from 1990 to 1996 and 2005 to 2009. TOLAC success was at its highest rate in 2000, 69.8 % (95 % CI 65.2-74.3 %) and its lowest in 2008, 38.5 % (95 % CI 28.1-48.8 %). The rate of TOLAC success increased significantly between 1990 and 2000, but declined thereafter an average of 3.4 % points per year (95 % CI -4.3 to -2.5). The rate of TOLAC in the US decreased between 1996 and 2005 and the rate of successful TOLAC has declined from 2000 to 2009. |
Sodium intake and blood pressure among US children and adolescents
Yang Q , Zhang Z , Kuklina EV , Fang J , Ayala C , Hong Y , Loustalot F , Dai S , Gunn JP , Tian N , Cogswell ME , Merritt R . Pediatrics 2012 130 (4) 611-9 OBJECTIVE: To assess the association between usual dietary sodium intake and blood pressure among US children and adolescents, overall and by weight status. METHODS: Children and adolescents aged 8 to 18 years (n = 6235) who participated in NHANES 2003-2008 comprised the sample. Subjects' usual sodium intake was estimated by using multiple 24-hour dietary recalls. Linear or logistic regression was used to examine association between sodium intake and blood pressure or risk for pre-high blood pressure and high blood pressure (pre-HBP/HPB). RESULTS: Study subjects consumed an average of 3387 mg/day of sodium, and 37% were overweight/obese. Each 1000 mg per day sodium intake was associated with an increased SD score of 0.097 (95% confidence interval [CI] 0.006-0.188, approximately 1.0 mm Hg) in systolic blood pressure (SBP) among all subjects and 0.141 (95% CI: -0.010 to 0.298, approximately 1.5 mm Hg) increase among overweight/obese subjects. Mean adjusted SBP increased progressively with sodium intake quartile, from 106.2 mm Hg (95% CI: 105.1-107.3) to 108.8 mm Hg (95% CI: 107.5-110.1) overall (P = .010) and from 109.0 mm Hg (95% CI: 107.2-110.8) to 112.8 mm Hg (95% CI: 110.7-114.9; P = .037) among those overweight/obese. Adjusted odds ratios comparing risk for pre-HBP/HPB among subjects in the highest versus lowest sodium intake quartile were 2.0 (95% CI: 0.95-4.1, P = .062) overall and 3.5 (95% CI: 1.3-9.2, P = .013) among those overweight/obese. Sodium intake and weight status appeared to have synergistic effects on risk for pre-HBP/HPB (relative excess risk for interaction = 0.29 (95% CI: 0.01-0.90, P < .05). CONCLUSIONS: Sodium intake is positively associated with SBP and risk for pre-HBP/HPB among US children and adolescents, and this association may be stronger among those who are overweight/obese. |
Nutritional risk factors for tuberculosis among adults in the United States, 1971-1992
Cegielski JP , Arab L , Cornoni-Huntley J . Am J Epidemiol 2012 176 (5) 409-22 The risk of developing tuberculosis (TB) may be related to nutritional status. To determine the impact of nutritional status on TB incidence, the authors analyzed data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS). NHANES I collected information on a probability sample of the US population in 1971-1975. Adults were followed up in 1982-1992. Incident TB cases were ascertained through interviews, medical records, and death certificates. TB incidences were compared across different levels of nutritional status after controlling for potential confounding using proportional hazards regression appropriate to the complex sample design. TB incidence among adults with normal body mass index was 24.7 per 100,000 person-years (95% confidence interval (CI): 13.0, 36.3). In contrast, among persons who were underweight, overweight, and obese, estimated TB incidence rates were 260.2 (95% CI: 98.6, 421.8), 8.9 (95% CI: 2.2, 15.6), and 5.1 (95% CI: 0.0, 10.5) per 100,000 person-years, respectively. Adjusted hazard ratios were 12.43 (95% CI: 5.75, 26.95), 0.28 (95% CI: 0.13, 0.63), and 0.20 (95% CI: 0.07, 0.62), respectively, after controlling for demographic, socioeconomic, and medical characteristics. A low serum albumin level also increased the risk of TB, but low vitamin A, thiamine, riboflavin, and iron status did not. A population's nutritional profile is an important determinant of its TB incidence. |
Effects of trimming weight-for-height data on growth-chart percentiles
Flegal KM , Carroll MD , Ogden CL . Am J Clin Nutr 2012 96 (5) 1051-5 BACKGROUND: Before estimating smoothed percentiles of weight-for-height and BMI-for-age to construct the WHO growth charts, WHO excluded observations that were considered to represent unhealthy weights for height. OBJECTIVE: The objective was to estimate the effects of similar data trimming on empirical percentiles from the CDC growth-chart data set relative to the smoothed WHO percentiles for ages 24-59 mo. DESIGN: We used the nationally representative US weight and height data from 1971 to 1994, which was the source data for the 2000 CDC growth charts. Trimming cutoffs were calculated on the basis of weight-for-height for 9722 children aged 24-71 mo. Empirical percentiles for 7315 children aged 24-59 mo were compared with the corresponding smoothed WHO percentiles. RESULTS: Before trimming, the mean empirical percentiles for weight-for-height in the CDC data set were higher than the corresponding smoothed WHO percentiles. After trimming, the mean empirical 95th and 97th percentiles of weight-for-height were lower than the WHO percentiles, and the proportion of children in the CDC data set above the WHO 95th percentile decreased from 7% to 5%. The findings were similar for BMI-for-age. However, for weight-for-age, which had not been trimmed by the WHO, the empirical percentiles before trimming agreed closely with the upper percentiles from the WHO charts. CONCLUSION: WHO data-trimming procedures may account for some of the differences between the WHO growth charts and the 2000 CDC growth charts. |
Nanomaterial interactions with biological systems: implications for occupational health
Iavicoli I , Schulte PA , Iavicoli S . J Nanomater 2012 2012 1-2 Nanotechnology is a system of innovative methods for controlling and manipulating matter at the near-atomic scale to produce engineered materials, structures, and devices. Engineered nanoparticles are generally considered to be a class or subset of nanomaterials with at least one dimension, that is, approximately 1 to 100 nanometers. The specific attractive properties of nanomaterials have led to their widespread application in many sectors, such as medicine, consumer products, energy, materials, and manufacturing. However, the limited but positive knowledge regarding engineered nanoparticle toxicological profiles, the potential greater biological reactivity due to the high-surface area-size ratio, and the increased likelihood of human exposure has raised several concerns about the potential adverse health effects for general and occupational exposed population. Additionally, there is a continuing interest in incidental nanoparticle exposure, not intentionally produced by anthropogenic sources, namely, processes involving combustion, welding, or diesel engines. The main scope of this special issue is to contribute original in vitro and in vivo research articles as well as review articles that seek to define the nanomaterial interactions with biological systems that could be relevant in understanding the implications of nanoparticle exposure for the workers’ health. We have invited colleagues from worldwide who have been exploring their research in this field. |
Pilot study of aromatic hydrocarbon adsorption characteristics of disposable filtering facepiece respirators that contain activated carbon
Rozzi T , Snyder J , Novak D . J Occup Environ Hyg 2012 9 (11) 624-9 Disposable filtering facepiece respirators (FFRs) used by health care workers are not designed to reduce the inhalation of volatile organic compounds (VOCs). Smoke-generating surgical procedures release VOCs and have been associated with the following complaints: foul smell, headaches, nausea, irritated throat and lungs, and asthma. Organic vapor FFRs that contain activated carbon are used by industrial workers to provide odor relief. These respirators remove irritating odors but are not marketed as respirators that provide respiratory protection against a gas or vapor. This study investigated the aromatic hydrocarbon adsorption capabilities of nuisance organic vapor (OV) FFRs. Three OV FFR models were tested to determine the 10% breakthrough time of three aromatic hydrocarbons at ambient room temperature and relative humidity. All respirator models were exposed to each vapor separately in three duplicate tests (n = 27). The respirator was sealed with silicone to an AVON-ISI headform that was placed in a chamber and exposed to VOC-laden air (20 ppm, 37 L/min). Periodically, gas samples were directed to an SRI gas chromatograph (Model 8610C) for analysis. All respirators performed similarly. The average 10% breakthrough values for all tests were at least 64 min, 96 min, and 110 min for benzene, toluene, and xylene, respectively. Respirators were tested with challenge concentrations at nuisance levels (20 ppm) and did not exceed 10% breakthrough values for at least 61 min. While the results of this pilot study hold promise, there is a need for further investigation and validation to determine the effectiveness of nuisance FFRs in mitigating organic vapors such as benzene, toluene, and xylene. |
Are exhalation valves on n95 filtering facepiece respirators beneficial at low-moderate work rates: an overview
Roberge RJ . J Occup Environ Hyg 2012 9 (11) 617-23 Exhalation valves (EVs) are touted as useful in dissipating humidity, heat, and carbon dioxide from the dead space of N95 filtering facepiece respirators and decreasing exhalation resistance, thereby making the respirator more comfortable and less physiologically demanding. Despite decades of use, there is limited research on the psychophysiological impact of EVs on the wearer at the current, low-moderate work rates of many workers. The available literature indicates that past and current EVs on the market decrease exhalation resistance to a variable degree and may improve dead space heat dissipation and, consequently, the temperature of the skin covered by the respirator. EVs have little substantial effect on dead space humidity, respiratory rate, heart rate, core temperature, speech intelligibility, or dead space oxygen and carbon dioxide levels at the aforementioned work rates. The studies also indicate that EVs may impact comfort and tolerance when N95 filtering facepiece respirators are worn for extended periods or at high work rates. Because comfort and tolerance impact respirator use compliance and, by extension, protection, more research into the psychophysiological impact of EVs on wearers and the development of new EVs tailored for low-moderate work rates are warranted. |
Characterization of frequency-dependent responses of the vascular system to repetitive vibration
Krajnak K , Miller GR , Waugh S , Johnson C , Kashon ML . J Occup Environ Med 2012 54 (8) 1010-6 OBJECTIVE: Occupational exposure to hand-transmitted vibration can result in damage to nerves and sensory loss. The goal of this study was to assess the frequency-dependent effects of repeated bouts of vibration on sensory nerve function and associated changes in nerves. METHODS: The tails of rats were exposed to vibration at 62.5, 125, or 250 Hz (constant acceleration of 49 m/s) for 10 days. The effects on sensory nerve function, nerve morphology, and transcript expression in ventral tail nerves were measured. RESULTS: Vibration at all frequencies had effects on nerve function and physiology. However, the effects tended to be more prominent with exposure at 250 Hz. CONCLUSION: Exposure to vibration has detrimental effects on sensory nerve function and physiology. However, many of these changes are more prominent at 250-Hz exposure than at lower frequencies. |
Schistosoma mansoni morbidity among school-aged children: a SCORE project in Kenya
Samuels AM , Matey E , Mwinzi PN , Wiegand R , Muchiri G , Ireri E , Hyde M , Montgomery SP , Karanja DM , Secor WE . Am J Trop Med Hyg 2012 87 (5) 874-82 Schistosomiasis control programs aim to reduce morbidity but are evaluated by infection prevalence and intensity reduction. We present baseline cross-sectional data from a nested cohort study comparing indicators of morbidity for measuring program impact. Eight hundred twenty-two schoolchildren 7-8 years of age from Nyanza Province, Kenya, contributed stool for diagnosis of Schistosoma mansoni and soil-transmitted helminths (STH) and blood smears for malaria, and were evaluated for anemia, quality of life, exercise tolerance, anthropometry, and ultrasound abnormalities. Schistosoma mansoni, STH, and malaria infection prevalence were 69%, 25%, and 8%, respectively. Only anemia and S. mansoni infection (adjusted odds ratio [aOR] = 1.70; confidence interval [CI] = 1.03-2.80), and hepatomegaly and heavy S. mansoni infection (aOR = 2.21; CI = 1.19-4.11) were associated. Though anemia and hepatomegaly appeared most useful at baseline, additional morbidity indicators may be sensitive longitudinal measures to evaluate schistosomiasis program health impact. |
Mechanism of anemia in Schistosoma mansoni-infected school children in western Kenya
Butler SE , Muok EM , Montgomery SP , Odhiambo K , Mwinzi PM , Secor WE , Karanja DM . Am J Trop Med Hyg 2012 87 (5) 862-7 A better understanding of the mechanism of anemia associated with Schistosoma mansoni infection might provide useful information on how treatment programs are implemented to minimize schistosomiasis-associated morbidity and maximize treatment impact. We used a cross-sectional study with serum samples from 206 Kenyan school children to determine the mechanisms in S. mansoni-associated anemia. Serum ferritin and soluble transferrin receptor levels were measured by using an enzyme-linked immunosorbent assay. Results suggest that S. mansoni-infected persons are more likely (odds ratio = 3.68, 95% confidence interval = 1.33-10.1) to have levels of serum ferritin (> 100 ng/mL) that are associated with anemia of inflammation (AI) than S. mansoni-uninfected children. Our results suggest that AI is the most common form of anemia in S. mansoni infections. In contrast, the mechanism of anemia in S. mansoni-uninfected children was iron deficiency. Moreover, the prevalence of AI in the study participants demonstrated a significant trend with S. mansoni infection intensity (P < 0.001). Our results are consistent with those observed in S. japonicum-associated anemia. |
Influenza and malaria co-infection among young children in western Kenya, 2009-2011
Thompson MG , Breiman RF , Hamel MJ , Desai M , Emukule G , Khagayi S , Shay DK , Morales K , Kariuki S , Bigogo GM , Njenga MK , Burton DC , Odhiambo F , Feikin DR , Laserson KF , Katz MA . J Infect Dis 2012 206 (11) 1674-84 BACKGROUND: Although children <5 years old in sub-Saharan Africa are vulnerable to both malaria and influenza, little is known about co-infection. METHODS: This retrospective, cross-sectional study in rural western Kenya examined outpatient visits and hospitalizations associated with febrile acute respiratory illness (ARI) during a two-year period (July 2009 - June 2011) in children <5 years old. RESULTS: Across sites, 45% (149/331) of influenza-positive cases were co-infected with malaria, while only 6% (149/2408) of malaria-positive patients were co-infected with influenza. Depending on age, co-infection was present in 4-8% of outpatient visits and 1-3% of inpatient admissions for febrile ARI. Children with influenza were less likely than those without to have malaria (risk ratios [RRs] = 0.57-0.76 across sites and ages), and children with malaria were less likely than those without to have influenza (RRs = 0.36-0.63). Among co-infected children aged 24-59 months hospital length of stay was 2.7 and 2.8 days longer than influenza-only infected children at the two sites, and 1.3 and 3.1 days longer than those with malaria-only (p's < .01). CONCLUSIONS: Co-infection with malaria and influenza was uncommon but associated with longer hospitalization than single infections among children 24-59 months old. |
Acute pulmonary schistosomiasis in travelers: case report and review of the literature
Pavlin BI , Kozarsky P , Cetron MS . Travel Med Infect Dis 2012 10 209-19 We report the case of an American traveler who developed acute pulmonary schistosomiasis after swimming in a lake in Madagascar, and we review the literature on acute pulmonary schistosomiasis. Schistosomiasis is one of the world's most prevalent parasitic diseases, with three species (Schistosoma mansoni, Schistosomahaematobium and Schistosomajaponicum) causing the greatest burden of disease. Pulmonary manifestations may develop in infected travelers from non-endemic areas after their first exposure. The pathophysiology of acute pulmonary disease is not well-understood, but is related to immune response, particularly via inflammatory cytokines. Diagnosis of schistosomiasis may be either through identification of characteristic ova in urine or stool or through serology. Anti-inflammatory drugs can provide symptomatic relief; praziquantel, the mainstay of chronic schistosomiasis treatment, is likely not effective against acute disease; the only reliable prevention remains avoidance of contaminated freshwater in endemic areas, as there is no vaccine. Travelers who have been exposed to potentially contaminated freshwater in endemic areas should seek testing and, if infected, treatment, in order to avoid severe manifestations of acute schistosomiasis and prevent complications of chronic disease. Clinicians are reminded to elicit a detailed travel and exposure history from their patients. |
Development of clinical immunity to malaria in highland areas of low and unstable transmission
Rolfes MA , McCarra M , Magak NG , Ernst KC , Dent AE , Lindblade KA , John CC . Am J Trop Med Hyg 2012 87 (5) 806-12 In highland areas of unstable, low malaria transmission, the extent to which immunity to uncomplicated malaria develops with age and intermittent parasite exposure has not been well characterized. We conducted active surveillance for clinical malaria during April 2003-March 2005 in two highland areas of western Kenya (Kapsisiywa and Kipsamoite). In both sites, annual malaria incidence was significantly lower in persons ≥ 15 years of age than in persons < 5 years of age (Kapsisiywa: incidence = 382.9 cases/1,000 persons among persons < 1-4 years of age versus 135.1 cases/1,000 persons among persons ≥ 15 years of age; Kipsamoite: incidence = 233.0 cases/1,000 persons in persons < 1-4 years of age versus 43.3 cases/1,000 persons in persons ≥ 15 years of age). In Kapsisiywa, among persons with malaria, parasite density and axillary body temperature were also significantly lower in persons ≥ 15 years of age than in persons < 5 years of age. Even in highland areas of unstable and low malaria transmission, age is associated with development of clinical immunity to malaria. |
Evaluating the sustained health impact of household chlorination of drinking water in rural Haiti
Harshfield E , Lantagne D , Turbes A , Null C . Am J Trop Med Hyg 2012 87 (5) 786-795 The Jolivert Safe Water for Families program has sold sodium hypochlorite solution (chlorine) and conducted household visits in rural Haiti since 2002. To assess the impact of the program on diarrheal disease, in 2010 we conducted a survey and water quality testing in 201 program participants and 425 control households selected at random. Fifty-six percent of participants (versus 10% of controls) had free chlorine residuals between 0.2 and 2.0 mg/L, indicating correct water treatment. Using intention-to-treat analysis, we found that significantly fewer children in participant households had an episode of diarrhea in the previous 48 hours (31% versus 52%; P = 0.001) with 59% reduced odds (odds ratio = 0.41, 95% confidence interval = 0.21-0.79). Treatment-on-treated estimates of the odds of diarrhea indicated larger program effects for participants who met more stringent verifications of participation. Diarrheal disease reduction in this long-term program was comparable with that seen in short-term randomized, controlled interventions, suggesting that household chlorination can be an effective long-term water treatment strategy. |
Evaluation of an HIV prevention intervention designed for African American women: results from the SISTA community-based organization behavioral outcomes project
Sapiano TN , Moore A , Kalayil EJ , Zhang X , Chen B , Uhl G , Patel-Larson A , Williams W . AIDS Behav 2012 17 (3) 1052-67 One of the Centers for Disease Control and Prevention's strategies for addressing racial disparities within the HIV epidemic is to support the implementation of HIV prevention behavioral interventions designed for African Americans. One such intervention is Sisters Informing Sisters about Topics on AIDS (SISTA), a culturally relevant and gender-specific, five-session, group-level, HIV prevention intervention designed for African American women. In 2008, the Centers for Disease Control and Prevention funded five community-based organizations to conduct outcome monitoring of SISTA to assess the outcomes associated with implementation in the field. Using a 90-day recall, demographic and sexual risk data were collected from participants at baseline and at 90 and 180 days post-intervention. Findings reveal that women participating in SISTA (n = 432) demonstrated a significant reduction in sexual risk between baseline and both follow-up time points for each of the six outcomes being measured (e.g., any unprotected sex, all protected sex). |
Exogenous predictors of national performance measures for emergency department crowding
Pines JM , Decker SL , Hu T . Ann Emerg Med 2012 60 (3) 293-8 STUDY OBJECTIVE: We explore the relationship between exogenous-level predictors and performance on 4 emergency department (ED) throughput measures approved by the National Quality Forum: median ED length of visit for admitted and discharged patients, median waiting time, and rate of left without being seen. We seek to find predictors for benchmarking and public reporting. METHODS: This was a study of 424 US hospitals that reported data to the National Hospital Ambulatory Care Survey in 2008 to 2009. Wald F tests and generalized linear models were used to test the relationship between exogenous variables (case mix, age mix, ED volume, teaching status, and Metropolitan Statistical Area status) and performance on the measures. RESULTS: Median waiting time was 35 minutes (95% confidence interval [CI] 26 to 43 minutes), median length of visit for patients treated but not admitted was 131 minutes (95% CI 121 to 142 minutes), median length of visit for patients admitted was 244 minutes (95% CI 218 to 270 minutes), and rate of left without being seen was 1.3% (95% CI 0.9% to 1.8%). Most exogenous variables, including ED volume, Metropolitan Statistical Area, teaching hospital status, age mix, and case mix, demonstrated significant association with waiting times and lengths of visit. Older age and a higher proportion of respiratory complaints were associated with differences in rates of left without being seen. CONCLUSION: Several exogenous factors outside of a hospital's control are associated with National Quality Forum-approved ED performance measures, which will have important implications for future benchmarking and public reporting of these data. |
Field epidemiology and laboratory training programs in West Africa as a model for sustainable partnerships in animal and human health
Becker KM , Ohuabunwo C , Ndjakani Y , Nguku P , Nsubuga P , Mukanga D , Wurapa F . J Am Vet Med Assoc 2012 241 (5) 572-9 The concept of animal and human health experts working together toward a healthier world has been endorsed, but challenges remain in identifying concrete actions to move this one health concept from vision to action. In 2008, as a result of avian influenza outbreaks in West Africa, international donor support led to a unique opportunity to invest in Field Epidemiology and Laboratory Training Programs (FELTPs) in the region that engaged the animal and human health sectors to strengthen the capacity for prevention and control of zoonotic diseases. The FELTPs mixed 25% to 35% classroom and 65% to 75% field-based training and service for cohorts of physicians, veterinarians, and laboratory scientists. They typically consisted of a 2-year course leading to a master's degree in field epidemiology and public health laboratory management for midlevel public health leaders and competency-based short courses for frontline public health surveillance workers. Trainees and graduates work in multidisciplinary teams to conduct surveillance, outbreak investigations, and epidemiological studies for disease control locally and across borders. Critical outcomes of these programs include development of a cadre of public health leaders with core skills in integrated disease surveillance, outbreak investigation, vaccination campaigns, laboratory diagnostic testing, and epidemiological studies that address priority public health problems. A key challenge exists in identifying ways to successfully scale up and transform this innovative donor-driven program into a sustainable multisectoral one health workforce capacity development model. |
Adopting healthy and sustainable food service guidelines: emerging evidence from implementation at the United States Federal Government, New York City, Los Angeles County, and Kaiser Permanente
Kimmons J , Wood M , Villarante JC , Lederer A . Adv Nutr 2012 3 (5) 746-8 For many Americans, what we eat daily is determined by the available foods in institutional settings such as schools, day care centers, workplaces, hospitals, correctional facilities, and senior centers. Guidelines supporting healthy and sustainable food service at institutions can assist in increasing the availability of healthy choices, thus influencing the diet of a large portion of the US population. The increase in market demand for healthier foods due to institutional guidelines can affect the food system at large, potentially leading to a general overall increase in the production and availability of healthier foods. Healthy and sustainable food service guidelines, such as the US Department of Health and Human Services (HHS)8 and the General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines) or the 2009 Institute of Medicine school meal nutrition recommendations, can be used for procuring, preparing, serving, and selling healthier foods and beverages with the intent of improving the quality of dietary intake and increasing the ecological benefits to the food system (1, 2). | The 2012 Experimental Biology symposium “Healthy and Sustainable Food Service Guidelines: Emerging Evidence from Implementation at the United States Federal Government, New York City, Los Angeles County, and Kaiser Permanente” presented emerging data on the process and early outcomes of implementing food service guidelines. The actions by these 4 unique entities represent large-scale efforts at chronic disease prevention. Due to the unique characteristics of each of these settings, the strategies for developing, evaluating, and implementing food service guidelines vary widely. |
Male circumcision programmes in Kenya: lessons from the Kenya AIDS Indicator Survey 2007
Mwandi Z , Bunnell R , Cherutich P , Mermin J , Kim AA , Gichangi A , Mureithi P , Kellogg TA , Oluoch T , Muttunga J , Ngare C , Kim E , Kaiser R . Bull World Health Organ 2012 90 (9) 642-51 OBJECTIVE: To provide guidance for male circumcision programmes in Kenya by estimating the population of uncircumcised men and investigating the association between circumcision and infection with the human immunodeficiency virus (HIV), with particular reference to uncircumcised, HIV-uninfected men. METHODS: Data on men aged 15 to 64 years were derived from the 2007 Kenya AIDS Indicator Survey, which involved interviews and blood collection to test for HIV and herpes simplex virus 2 (HSV-2). The prevalence of HIV infection and circumcision in Kenyan provinces was calculated and the demographic characteristics and sexual behaviour of circumcised and uncircumcised, HIV-infected and HIV-uninfected men were recorded. FINDINGS: The national prevalence of HIV infection in uncircumcised men was 13.2% (95% confidence interval, CI: 10.8-15.7) compared with 3.9% (95% CI: 3.3-4.5) among circumcised men. Nyanza province had the largest estimated number of uncircumcised, HIV-uninfected men (i.e. 601,709), followed by Rift Valley, Nairobi and Western Province, respectively, and most belonged to the Luo ethnic tribe. Of these men, 77.8% did not know their HIV status and 33.2% were HSV-2-positive. In addition, 65.3% had had unprotected sex with a partner of discordant or unknown HIV status in the past 12 months and only 14.7% consistently used condoms with their most recent partner. However, only 21.8% of the uncircumcised, HIV-uninfected men aged 15 to 19 years were sexually active. CONCLUSION: The Kenyan male circumcision strategy should focus on the provinces with the highest number of uncircumcised, HIV-uninfected men and target young men before or shortly after sexual debut. |
Mental health needs assessment after the Gulf Coast oil spill-Alabama and Mississippi, 2010
Buttke D , Vagi S , Bayleyegn T , Sircar K , Strine T , Morrison M , Allen M , Wolkin A . Prehosp Disaster Med 2012 27 (5) 1-8 INTRODUCTION: Previous oil spills and disasters from other human-made events have shown that mental health effects to the affected population are widespread and can be significant. HYPOTHESIS/PROBLEM: There has been concern regarding the likelihood that existing public health surveillance was not capturing the mental health effects to the population affected by the Gulf Coast oil spill. The objectives of this study were to assess the mental health needs of coastal communities in the states of Alabama and Mississippi following the Deepwater Horizon oil spill. METHODS: A cluster sampling methodology was used to assess the mental health status of coastal residents in three counties in Alabama four months following the 2010 Deepwater Horizon oil spill, and in the Gulf Coast counties in Mississippi 5.5 months after the oil spill. RESULTS: A total of 469 residents of the selected areas were interviewed. Between 15.4 and 24.5% of the respondents reported depressive symptoms, with 21.4-31.5% reporting symptoms consistent with an anxiety disorder, and 16.3-22.8% reporting ≥14 mentally unhealthy days within the past 30 days. Overall, there were more negative quality of life indicators and negative social context outcomes than in the state's Behavioral Risk Factor Surveillance System (BRFSS) survey. Between 32.1% and 35.7% of all households reported decreased income since the oil spill, and 35.5-38.2% of all households reported having been exposed to oil. CONCLUSION: The proportion of respondents reporting negative mental health parameters in the affected Alabama and Mississippi coastal communities is higher than the proportion reported in the 2008 and 2009 BRFSS state reports, suggesting that the public health response to the Deepwater Horizon oil spill should focus on mental health services in these communities. |
Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study
Lopes Cardozo B , Gotway Crawford C , Eriksson C , Zhu J , Sabin M , Ager A , Foy D , Snider L , Scholte W , Kaiser R , Olff M , Rijnen B , Simon W . PLoS One 2012 7 (9) e44948 BACKGROUND: International humanitarian aid workers providing care in emergencies are subjected to numerous chronic and traumatic stressors. OBJECTIVES: To examine consequences of such experiences on aid workers' mental health and how the impact is influenced by moderating variables. METHODOLOGY: We conducted a longitudinal study in a sample of international non-governmental organizations. Study outcomes included anxiety, depression, burnout, and life and job satisfaction. We performed bivariate regression analyses at three time points. We fitted generalized estimating equation multivariable regression models for the longitudinal analyses. RESULTS: Study participants from 19 NGOs were assessed at three time points: 212 participated at pre-deployment; 169 (80%) post-deployment; and 154 (73%) within 3-6 months after deployment. Prior to deployment, 12 (3.8%) participants reported anxiety symptoms, compared to 20 (11.8%) at post-deployment (p = 0.0027); 22 (10.4%) reported depression symptoms, compared to 33 (19.5%) at post-deployment (p = 0.0117) and 31 (20.1%) at follow-up (p = .00083). History of mental illness (adjusted odds ratio [AOR] 4.2; 95% confidence interval [CI] 1.45-12.50) contributed to an increased risk for anxiety. The experience of extraordinary stress was a contributor to increased risk for burnout depersonalization (AOR 1.5; 95% CI 1.17-1.83). Higher levels of chronic stress exposure during deployment were contributors to an increased risk for depression (AOR 1.1; 95% CI 1.02-1.20) comparing post- versus pre-deployment, and increased risk for burnout emotional exhaustion (AOR 1.1; 95% CI 1.04-1.19). Social support was associated with lower levels of depression (AOR 0.9; 95% CI 0.84-0.95), psychological distress (AOR = 0.9; [CI] 0.85-0.97), burnout lack of personal accomplishment (AOR 0.95; 95% CI 0.91-0.98), and greater life satisfaction (p = 0.0213). CONCLUSIONS: When recruiting and preparing aid workers for deployment, organizations should consider history of mental illness and take steps to decrease chronic stressors, and strengthen social support networks. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
- Health Behavior and Risk
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Program Evaluation
- Public Health Leadership and Management
- Reproductive Health
- Social and Behavioral Sciences
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure